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General NPI Number Information
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NPI Number | 1285356030
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Entity Type | Organization
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Legal Business Name | BRAVE COUNSELING AND CONSULTATION LLC
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 1512 W 6TH AVE STE B
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City | EMPORIA
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State | KS
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Zip | 66801-2400
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Country | US
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Telephone | 620-208-6577
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Fax | 620-412-8954
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Provider Business Mailing Address
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Address Line | 982 ROAD 220
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City | EMPORIA
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State | KS
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Zip | 66801-7930
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TYSON PROUSE
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Credential |
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Telephone | 620-794-6635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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